Going the extra mile

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What does it take to deliver healthcare to a neglected population in a remote region? Dr Ram Kovelamudi, working with MSF in Bhadrachalam, Telangana, explains.

I have worked as a doctor in different settings before. But I always felt something was missing. The patients I was treating would always have other doctors to go to. But being able to help patients who have no one else to go to, for whom you are the only option of medical care, is a very different experience; it gives you a tremendous sense of satisfaction.

It is this sense of satisfaction I have experienced in the past year, working with MSF in the remote areas of Chhattisgarh, Andhra Pradesh and Telangana. The remote context, coupled with the ongoing crises in the region, makes it extremely difficult for the tribal people in these areas to access healthcare.

In order to reach them, MSF conducts mobile clinics every week in remote forest villages. From reproductive care and immunisation to treatment for malaria, TB, skin diseases and diarrhoea, our teams provide free primary healthcare to the vulnerable people. Patients sometimes travel 20-30 kilometres to meet us. You would think it is for an emergency, but it is often for skin rashes and body aches. These may not be big things for us, but these are huge problems for the people there. That they have to travel so far for basic healthcare – for a paracetamol! – shows how much our work is needed.

If we come across any complicated cases in our mobile clinics, we refer them to Bhadrachalam, a town in the Khammam district of Telangana. From reimbursing the cost of travel to and from Bhadrachalam to covering the medical and food expenses, our medical teams support the patient throughout their treatment.

I remember a one-year-old-child who was brought to our mobile clinic in Mallampeta, a small village in Andhra Pradesh, with burns all over his body. He had accidentally fallen into hot water. We referred him to medical facilities in Bhadrachalam, Warangal and Hyderabad for follow-ups. It took almost six months for him to get better, but our efforts paid off. I wonder what would have happened had the child not been brought to us in time.

The lack of availability of treatment, together with low levels of health awareness, has meant that common, easily treatable ailments can sometimes assume life-threatening proportions. Take malaria, for instance. During peak season (July-October), if we are treating 100 patients, approximately 60 of them are malaria positive. In 2015, we treated over 13,000 malaria patients.

Along with malaria, malnutrition is a huge problem. We often get malaria patients who are also severely anaemic. Children no older than 2 years often come to us with bloated spleens. It is a life-threatening situation, but it doesn’t faze parents.

It used to shock me at first, but the reality is that the woeful health infrastructure has badly affected people’s health-seeking behavior. Since there are no hospitals with even the most basic infrastructure nearby, they have to travel a distance of 50-100 kilometres on bad, uneven roads, to get healthcare.

We have been carrying out health education to bring about an awareness about common diseases, but it is not easy to change habits and lifestyles that are centuries old. Still, even in the one year that I have worked here, I have seen remarkable improvement. People know that cough is related to TB, itching is related to scabies, which was not the case before. That is very heartening.

Personally, too, the journey has been gratifying. Working with MSF has made me sensitive to things that I would dismiss in my ignorance. When I see the dedication of people who walk for hours to get medicines, it inspires me and tells me I need to do a lot more.

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